Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1124424155 |
---|---|
Provider Name | Olivia Green |
First Address | San Antonio, TX 78217-5419 |
Second Address | San Antonio, TX 78217-5407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2014 |
Last Update Date | 19/11/2014 |